Describe the overall management approach.
Follow ABCDE approach and check pulse.
Pulseless patients: Start CPR (see “ACLS”).
Pulse present: Evaluate hemodynamic stability.
Clinical features of unstable bradycardia present: Follow adult unstable bradycardia algorithm.
Stable bradycardia: Manage according to underlying etiology and symptom severity.
Patients with unstable bradycardia need immediate stabilization with IV atropine, temporary cardiac pacing, and/or IV chronotropic medication, e.g., dopamine or epinephrine. [1]
Patients asymptomatic stable bradycardia or only mildly symptomatic stable bradycardia typically do not require acute intervention.
Approach (figure).
Describe the initial management of bradycardia.
Call for help.
Unstable bradycardia: Begin stabilization according to the adult unstable bradycardia algorithm.
Evaluate underlying rhythm.
Unstable patients: Obtain rhythm strip first.
All patients: Obtain 12-lead ECG.
Identify and treat reversible causes of bradycardia, e.g., supplemental O2 for hypoxemia. [2][3]
Do not delay acute stabilization of unstable bradycardia to obtain a 12-lead ECG for rhythm identification.
Overview bradyarrhythmias (table).
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